When COVID-19 is no longer a pandemic: How our reality changes

In April 2021, I pitched a story idea to my editors: "How to cope with post-pandemic anxiety." As vaccines became widely available, I pictured parties with no masks, handshakes with no fear and all the other markers of a world going back to "normal." In this imminent post-pandemic future, I thought my biggest challenge would be re-adjusting to life outside my cocoon.

Half a year and several new COVID variants later, it has become clear that the very concept of "post-pandemic" requires re-examining. For starters, it's not clear what it means for a pandemic to end -- even scientists disagree on where to draw the line. And across the nation and world, there are wildly varying levels of coronavirus spread, vaccination rates and mitigation measures. In one state, day-to-day life may certainly feel post-pandemic, with little mask-wearing or social distancing. In a neighboring state, COVID may very much feel like a constant presence still.

Perhaps "post-pandemic" is like art: You know it when you see it. But however you define the end of the COVID pandemic, one fact remains true: It continues to escape our grasp. New, more transmissible variants push the light at the end of the tunnel back further and further, as does hesitancy around vaccines, and other factors. 

You can take heart in the fact that pandemics do, by nature, come to an eventual end. But not in the way that you think. When I pictured post-pandemic life in April 2021, I pictured the threat of COVID going away entirely, like one big switch flipped across the whole world at once. But the end of a pandemic isn't sudden, grand or neat. In fact, experts now believe that COVID will always be with us -- just not in pandemic form. And the pandemic will continue to shape our lives in some ways, even after it's over.

Here's what the end of the COVID pandemic will really look like, how we can get there, and what you can expect life to look like afterward.

How pandemics like COVID-19 end

There are a few ways that a pandemic can potentially end. The disease can be eradicated completely: zero cases, anywhere in the world, ever again. We can reach herd immunity, when enough people in a certain region are immune to the disease that it's eliminated there (that's what happened in the US with measles). Or the disease could become endemic: it continues circulating at a predictable baseline level, but is no longer a major health threat to most people.

With COVID, our best bet is the latter scenario, according to current expertise. In a January 2021 Nature survey of over 100 immunologists, virologists and infectious disease researchers, almost 90% said they think the coronavirus will become endemic. Herd immunity is an increasingly unrealistic goal, and eradication is unlikely -- throughout recorded history, only two diseases have ever been eradicated: smallpox and a cattle virus called rinderpest. Even the plague is here to stay.

"When SARS-CoV-2, the virus causing COVID-19 first appeared, it was new, unexpected, and quickly spread around the world," Mackenzie Weise, an epidemiologist with Wolters Kluwer Health, tells CNET. "It's realistic to think that circulation of the SARS-CoV-2 virus won't just suddenly end."

The good news: Living with an endemic disease is strikingly different from living in a pandemic. Just take the flu. The H1N1 virus that caused the Spanish flu pandemic killed more than 50 million people from 1918-1919. That virus never really went away -- it's the genetic ancestor of the seasonal influenzas that still circulate every year. But the flu now results in far fewer deaths, and it impacts our lives in a more manageable way. 

"If [COVID] becomes endemic, it'll be like the flu," says Dr. Robert G. Lahita, director of the Institute for Autoimmune and Rheumatic Disease at St. Joseph's Health and author of the upcoming book Immunity Strong. "There'll be a spate of deaths every year in the US from the novel coronavirus or COVID, and there will also be deaths from flu, influenza, which there are every year."

We learned to live alongside the flu with a delicate balance of precaution and treatment, and we can one day do the same with SARS-CoV-2.

What life in a post-pandemic endemic world looks like

Living with the endemic version of COVID may look a lot like the post-pandemic world I envisioned back in April 2021. Mask mandates, social distancing, stay-at-home orders, travel restrictions and other mitigation measures will disappear in most places.

"I think that we will remove our masks and remove social distancing and go back to normal once this virus goes away," Lahita says. "And it will go away, but it will be with us in some form forever. The pandemic will go away."

COVID vaccines will still be necessary, possibly every year like the flu shot, Lahita says. They'll be especially important for people who are vulnerable to severe illness, like immunocompromised people and the elderly. Vaccine mandates may be here to stay, too -- the COVID vaccines could, for example, join the list of immunizations that children and teens are required to get in order to attend school. (So far, only California and Louisiana have gone that route.)

One sign that we've reached endemicity is that hospitalizations and deaths stay at a constant level, which health care services can predict and manage, and which the public considers an acceptable risk. As with other endemic diseases like the flu, COVID's impact on individual people will vary. To some of us, flu season is no big deal. To others, it's a risky and scary time. 

And truthfully, it would help if we kept wearing masks, washing our hands religiously and using other preventive measures against both flu and COVID, even after the pandemic stage. But in reality, only a small group of cautious people are willing to keep taking those steps once they're not required. For most, the cost of fear and isolation is too high.

"There's always the subset of the population that becomes very anxious and very obsessive. Those people will continue to wear masks and will socially distance and avoid groups and gatherings and restaurants and theaters and so on. There's always that subgroup," Lahita says.

Similarly, there will continue to be many people who hesitate to get a COVID vaccine. "Even when it becomes endemic and no longer a pandemic, people will still be arguing about not getting injected with antigen or with messenger RNA to protect them," Lahita says.

How we get there, and when

"The ideal scenario toward endemicity is that enough people receive immune protection in order to significantly reduce ongoing transmission, severe illnesses, hospitalizations and deaths," Weise explains. 

There are two ways to get immune protection from COVID: get vaccinated, or recover from a coronavirus infection. Of those two, it's easy to see why vaccination is the ideal route. "Because COVID-19 vaccines are extremely effective at preventing all the above, vaccine-induced immunity is the only logical path towards this goal," Weise says. As we've seen over and over in the last two years, battling a COVID infection is unpredictable and can have fatal outcomes in otherwise healthy people.

Weise continues: "I'm optimistic that we can reach a point when COVID-19 isn't a severe threat to most people, but we desperately need more people to step up and get vaccinated." To be more specific, Lahita predicts that at least a 50% vaccination rate in most countries would be necessary for endemicity to occur.

Because vaccines play such a crucial role in ending the pandemic, public health officials are working hard to get them into everyone's hands (or arms). But the pharmaceutical industry hasn't made it easy. Moderna and Pfizer, which have two of the most effective vaccines against COVID-19, have refused to share their mRNA technology with other companies or scientists. Meanwhile, high-income countries have been accused of "hoarding" vaccine doses and have failed to follow through on promises to donate enough extras to poorer countries to bridge the gap, despite pleas from the World Health Organization. 

As of this writing, only 3.7% of people in low-income countries have been fully vaccinated, compared to 69.1% in high-income countries. But even the US, with plenty of doses to go around, has struggled to meet goals for vaccination rate as a result of people who are vaccine-hesitant or resistant. As of the end of December, more than 65% of the US population ages 5 and older is fully vaccinated.

Their unvaccinated status has an impact on everyone, Weise explains: "The problem is that viral transmission is sustained among susceptible [unvaccinated] persons, and we can't anticipate how or where these people may interact with one another, or even with vaccinated persons to perpetuate further spread."

The more that the virus spreads, the more that it mutates into new variants, each of which has the potential to be more transmissible, more deadly, or more resistant to current vaccines. And unlike man-made vaccines, viruses know no borders.

With the majority of the world still not fully vaccinated, the end of the pandemic still feels like a long way off to many experts. "Eventually, I think that the virus will be controlled. It may take years, however, for that to happen, because of the unvaccinated masses," Lahita says.

It's also important to note that endemicity won't happen everywhere at once. Some places will reach this stage sooner, depending on vaccination and infection rates. New York City may be among the first cities in the US to get there, thanks to high rates of immunity from vaccines and prior infections. 

If the coronavirus continues to have such disproportionate impacts, it could become similar to malaria or HIV: the pandemic will be "over'' in richer countries, but still a deadly force in others. If that's the case, the WHO could downgrade it to an epidemic (like a pandemic, but not worldwide).

Has COVID-19 changed us for good?

Even after the pandemic ends, its society-wide effects may stay with us in ways that we can't predict quite yet. In addition to millions of lives lost, the pandemic created challenges and disruptions to every imaginable part of life, leading to a mental health crisis and collective trauma that will likely persist long after it's over.

But the long-term legacy of the COVID-19 pandemic may not be all negative. Past pandemics have led to new habits that improved health for years to come. Screen doors, for example, were popularized as a way to prevent malaria and other mosquito-borne diseases. The AIDS pandemic shifted condom usage into the mainstream, and the tuberculosis epidemic led people to stop sharing drinking cups and spitting in public. Some pandemics have also led to sweeping improvements in economics, education, housing and public health.

Will similar changes happen after COVID? In the University of California, Berkeley's World After COVID project, 57 scientists shared predictions about how the COVID-19 pandemic may change society, in both positive and negative ways. Their positive forecasts included greater solidarity, renewed social connections, and a greater effort to address our world's structural inequalities. 

Many experts in Berkeley's study also pointed to the embracing of technology, which played an unprecedented role in our lives when COVID-19 kept us indoors. During the pandemic, tech innovations like virtual reality and QR codes took on new life, not to mention the explosion in remote work and telehealth.

Similarly, in a Pew Research survey of 915 "innovators, developers, business and policy leaders, researchers and activists," almost all respondents agreed that we'll be living in a much more tech-driven society after the pandemic: a "tele-everything" world, with all its pros and cons. 

Remote work is likely here to stay, but that doesn't mean offices are doomed to disappear. Surveys show that most office workers would prefer not going back to the office full-time, but their bosses feel the opposite. If Australia's reopening is any indication, there won't be one single path forward -- instead, different companies will take different approaches, and we'll live with a mix of remote, in-office and hybrid work setups.

One thing the COVID pandemic has taught us is that you really just never know. The crisis exposed how delicate our regular routines are, on both an individual and a global scale. We've seen how difficult and yet surprisingly doable it is to adjust to a new normal, and how disarming it is not to know what to expect. Even experts aren't fortune tellers, and no one can say for sure when the pandemic will be declared over, or what will happen in the years to come.

The pandemic will continue to surprise us, even after it's over. But first, we have to get there.